Design as Preventative Care by Design as Preventative Care

Design As Preventative Care Achieving Climate Justice through Interdisciplinary Collaboration

A Publication of the Urban Design Forum 2019-20 Forefront Fellow Program Cyrus Blankinship Eileen Chen Gregory Harasym Catherine Joseph Amritha Mahesh Kathy Mu Jill Schmidt

Climate Change is a Public Health Emergency strategies in coastal zones and flood areas within the city. Less-recognized extreme climate events - extreme heat, water- and vector-borne diseases, and worsening air quality - also have a widespread and devastating effect and are similarly positioned to revolutionize the built environment.

Extreme heat events kill more people in the United States than all other natural disasters combined. Each year, NYC reports an average of 13 heat stroke deaths, 115 premature deaths due to extreme heat, 450 emergency department visits, and 150 hospital admissions for heat-related illness.1 Most heat–related deaths in New York City are caused not by sun exposure, but by exposure to extreme heat inside homes without air-conditioning. The built environment has a great effect on human health.

Public health emergencies can quickly become crises due to a lack of preparedness and clear communication, and undeveloped mitigation strategies. Pandemics can also instigate economic hardship. The health risks of extreme climate events imply dangerous public health scenarios, and target already vulnerable populations. In the US, heat events led to more weather-related fatalities than any other climate event over the past 30 years. From 1999 to 2010, exposure

Discord between the built environment and natural disasters is well-known, and the social and economic repercussions are well-documented. The damage caused by Hurricane Sandy has drastically changed planning and construction Interrelated Climate Risk Factors2

Increased Flooding & Storms

Increased Pollution & GHG Emissions

More Intense Wildfires

Changes in Precipitation

Increased Duration of Warm Seasion

Changes in Median Temperature

SECONDARY EFFECTS

More Frequent Heatwaves

VECTOR-BORNE DISEASES

AIR QUALITY IMPACTS

ENVIRONMENTAL EFFECTS

EXTREME WEATHER

Property Loss Infrastructure Damage Water Contamination

Increased Allergens

Urban Heat Island Effect

Aggravated Cardiovascular Illnesses

Heat Stroke Dehydration

Aggravated Respiratory Illnesses

Expanded Geographical Range

Increased Allergy-Related Illnesses

Injury & Death Water-Borne Illnesses

Compounded Risk in the Built Environment NYC MAYORAL ADMINISTRATION U.S. FEDERAL ADMINISTRATION

90 YEARS

MEDIAN AGE OF NYC RESIDENTIAL BUILDING

NYC AVG. LIFE EXPECTANCY

81.2 YEARS

2020

EAST HARLEM AVG. LIFE EXPECTANCY

77.3

2050

3X # OF 90°F+ DAYS 2

2080 UP TO 1.5X RAIN DAYS > 1”

Changes in Vector Behaviors

Increased Cases of Vector-Borne Diseases such as Lyme Disease, Malaria, Zika, Virus and West Nile Virus

HEALTH EFFECTS

RISING TEMPERATURE

to extreme heat was implicated in 7,415 deaths - an average of more than 600 per year.3 Referencing the Environmental Protection Agency’s Value of a Statistical Life, this amounts to more than $4.4 billion/year in mortality costs alone.4 Understanding the role that the built environment plays in human health is a first step. Only 22 percent of an individual’s health is due to genetics. The rest is a result of social determinants. Access to and quality of medical care accounts for 11 percent. The remaining 67 percent is a combination of the built environment, stability of social circumstance and economic status, and the effect that stability or instability has on mental and behavioral health.5 At least two-thirds of a person’s health is affected by

conditions separate from the inequities of health care and the inevitability of genetics. Policymakers, planners, and designers must address the significant role that the built environment and social and economic circumstances play in determining human health, particularly while preparing responses to and mitigation of climate change threats. The climate change crisis must be expanded to incorporate the associated public health risks, including those from extreme heat, air quality, and water-borne disease. These present opportunities to develop immediate responses and long-term solutions to reduce risk in the built environment.

Social Determinants of Health MEDICAL CARE 11%

From 1999

to 2010, exposure to extreme heat led to 7,415 deaths in the US - an average of more than 600 premature deaths per year. The

GENETICS & BIOLOGY 22%

associated mortality costs are estimated at more than BUILT ENVIRONMENT 7%

INDIVIDUAL BEHAVIOR 36%

$4,440,000,000 per year.7 180 million Americans will experience an average of 30+ days per year with a heat index above 105°F. That is 60% of the population of the

By 2065,

SOCIAL CIRCUMSTANCES 24%

contiguous United States. 7

Estimating the Emergency Costs of Climate Change Events Despite growing evidence of the impact of climate change events on public health, there is a lack of data surrounding the personal and societal costs of such events. A recent study published in GeoHealth sought to quantify these health-related costs by analyzing ten climate-sensitive events in 2012 that showcase the variety of complications climate change poses to public health: extreme heat in WI, wildfires in CA and CO, air pollution in NV, lyme disease in MI, extreme weather in OH, West Nile in TX, algae blooms on Florida coasts, allergenic oak pollen in NC, and the impacts of Hurricane Sandy in NY and NJ.6 The authors estimate a total cost of $10 billion from these specific events, resulting from 917 premature deaths, 20,568 hospitalizations (HA’s), 17,857 emergency department visits (ED’s), and 37,425 outpatient encounters (OC’s). $8.4 billion of the total amount is due to mortality costs which are calculated using the EPA’s Value of a Statistical life (VSL) of $7.4 million. The remainder is the sum of all morbidity costs, which is calculated by summing up the individual costs of HA’s, ED’s, OC’s, and the lost wages of hospitalizations.

The most expensive event was Hurricane Sandy, with a health-related cost of $3.1 billion: 273 premature deaths ($2.5 billion) 6,602 HA’s ($489 million) 4,673 ED’s ($137 million) 2,444 OC’s ($20.3 million) The cost of a singular heat event in Wisconsin was estimated at more than $250 million: 27 premature deaths ($246 million) 155 HA’s ($1.3 million) 1620 ED’s ($3.1 million) 57 OC’s ($0.6 million) The authors of the paper only included patients diagnosed with exposure to excessive heat, heat cramps, heat edema, heat exhaustion, heat fatigue, stroke, heat syncope, and sun stroke. However, the study did not include cardiovascular or respiratory health and thus likely underreports the total cost of the heat event. 3

Urban Planning & Public Health urban planning decisions created systemic conditions of social inequity evident today in New York City’s disparate health outcomes. The location of heavy infrastructure like expressways and bus depots with negative externalities have disproportionately burdened some neighborhoods to serve the city at-large. These neighborhoods often experience unjust health consequences such as higher rates of childhood asthma. These conditions are further exacerbated by extreme climates.

Extreme heat events demonstrate the risk that extreme climate events pose to the human body. In the case of heat, existing health conditions are exacerbated by extreme temperatures and further amplified by the built environment. The design of the built environment is rooted in mediating between the human body and the city to mitigate exposure and health risk. Urban planning emerged in response to the effects of industrialization and urbanization on human health and the built environment. Today, climate change poses similarly disruptive threat to well-being, but the relationship among urban planning and architecture and public health is not as well-defined.

C.S. Holling defined “resilience” as the “measure of the persistence of systems and of their ability to absorb change and disturbance and still maintain the same relationship between populations or state variables.”8 The notion of maintaining the same relationship, returning to the same state of existence, ignores the potential and need for progress.

Combined with the direct effects of extreme climate events is the history of racial-bias and inequity in the policy and planning that structures American cities. Past

Annual Precipitation (Inches)

Observed Annual Temperature in Central Park (Farenheit)

100 75 50

1845 | Friedrich Engels published The Condition of the Working Class of England.

1889 | Jacob Riis published How the Other Half Lives, documenting conditions in tenement houses.

1884 | Louis Pasteur research on pasteurization and anthrax vaccination paved way for germ theory by stating that microorganisms are the cause of disease.

25 0

1842 | Edwin Chadwick published The Sanitary Conditions of the Labouring Population of Great Britain.

1850 4

1878 | Following a yellow fever outbreak, Memphis created a comprehensive plan that established a new water and sewer system, bulldozed shantytowns, damned the bayous, built new parks and repaved roads to promote a healthy city.

1854 | John Snow mapped a cholera outbreak and traced the source back to a water pump on Broadwick Street in London, beginning the field of epidemiology.

By the mid-19th century, industrialized cities became overcrowded, polluted with waste, and coping with infectious disease outbreaks. Public health interventions focused on improving the sanitary conditions of the city including redeisgning water and sewage systems, building parks, and bringing more air into buildings.

1880s | American Park Movement led by Frank Olmsted brought green spaces into otherwise crowded city centers on the premise that social and public health problems stemmed from overcrowding and a lack of access to open space.

1880

1909 | City Beautiful Movement was ushered in with the new Plan of Chicago by Daniel Burnham, promoting monumental grandeur and beauty for its own sake in cities.

1890s | State and local health departments establish laboratories to monitor diseases. Thinking shifted to consider disease and wellness as both public and personal responsibilities. Science replaced the previous social, moral, religious, and sanitary measures to combat disease.

The American Parks Movement and advances in medicine and science explored the origins of disease. While planning and design disciplines focused on social elements of cities; health practitioners looked to scientific methods and thinking to monitor disease.

1901 | The Tenement House Act in New York State aimed to improve living conditions in tenements focusing on light and ventilation for fire safety and health.

1900

In the early 20th century, public health and urban planning interests began to diverge. Public health practitioners shifted their focus to science and personal care while the field of urban planning grew as a comprehensive attempt to look at neighborhoods and cities with economic implications.

1922 | Sheppard-Towner Act promoted the creation of community health centers, bringing clinical and social services to low-income populations in cities. Community members participated on the center boards. After being criticized as socialized medicine, the act was allowed to expire in 1929.

1916 | NYC was the first municipality to adopt a Comprehensive Zoning Resolution responding to concerns about overdevelopment. Some owners want to protect property values which was considered critical to the success of the whole city’s economy.

1934 | Robert Moses became Commissioner of the New York City Department of Parks. He began serving as Commissioner of New York City Planning Commission in 1942. He paved the way for multiple Expressway projects in New York City, displacing more than one-quarter of a million residents.

1923 | C. E. A. Winslow defined public health as the science of preventing contagious disease, and promoting physical health. Personal care became the crux of public health policy with health departments expanding into clinical care and health education.

1930

1937 | The City Planning and Housing Council (CHPC) was founded and played a large role in reconstructing urban slums, with the primary mission to eliminate poor housing conditions, creating less crowded and cleaner public housing.

Urban Renewal in the 1930’s and 1940’s focused on slum clearance for large-scale redevelopment projects, often implemented by local public housing authorities.

Efforts to address climate risk, design, and health equity must pay particular attention to vulnerabilities shaped by past planning decisions. Practitioners in this arena should consider focusing plans on “anti-resilience.” Shalanda H. Baker defines anti-resilience as “the quality of resisting the obfuscation of systemic violence enacted upon communities of color and the poor in the name of energy”.9 This concept, applied broadly to the design of the built environment, can transform how urban planners and architects engage with community leaders and organizations to shift transformations of our urban systems to pursue health equity.

1961 | The 1961 Zoning Resolution divided New York City into residential, commercial, and manufacturing areas.

1939 | Rene Dubos discovered gramicidin, the first antibiotic agent launching the era of antibiotics.

1948 | Framingham Heart Study discovered causes of cardiovascular disease and introduced the concept of risk factors and prevention into public health discourse.

1950

1969 | Congress Passes the National Environmental Policy Act to assess environmental impacts of Federal agencies’ actions.

1964 | U.S. Congress passes the Civil Rights Act of 1964, prohibiting use of federal or state funds to discriminate based on race, color, and national origin.

1986 | Residents of West Harlem fought against the siting of a sewage treatment plant in their community. The protests led to the founding of WE ACT in 1988.

1979 | Linda McKeever Bullard files the Bean v. Southwestern Waste Management Corp lawsuit on behalf of Houston’s Northeast Community Action Group, the first civil rights suit challenging the siting of a waste facility.

1980

1990 | A group of environmental leaders, activists, teachers, students, and artists wrote a letter to the nation’s ten biggest conservation groups charging them with a lack of support for the environmental justice movement, a history of exclusionary practices toward communities of color and lack of diversity within their ranks.

1987 | Dr. Benjamin Chavis coined the phrase “Environmental Racism” to explain the results of a study he aided — Toxic Waste and Race in the United States — exploring the direct relation between race and the frequency of hazardous waste sites placed near or in communities of color.

1994 | President Bill Clinton issued “Federal Actions to Address Environmental Justice in Minority Populations and LowIncome Populations” to address environmental injustice within existing federal laws and regulations.

1992 | EPA established the Office of Environmental Equity. The name was later changed to the Office of Environmental Justice in 1994.

The Environmental Justice Movement emerged out of the Civil Rights and Environmental Movements. After decades of grassroots mobilizing and community organizing against unjust planning and land use decisions, federal policies began to acknowledge environmental racism in the 1990’s.

Annual Average mcg per Cubic Meter (PM 2.5)

1977 | The supreme court ruled in Arlington Heights v. Metropolitan Housing Development — a landmark zoning case — that any break of the equal protection clause must be the result of both discriminatory intent and have led to discrepant outcomes. This ruling neglects to notice the non-racial reasons for hazardous zoning, like less political engagement or low land costs that often affect communities of color as a result of racial inequality.

1970 | The Environmental Protection Agency (EPA) was founded by the Federal government to consolidate federal efforts to ensure environmental protection.

The Civil Rights and Environmental Movements revealed the unequal siting of hazardous waste facilities, industrial plants, bus depots, sewage treatment plants and other infrastructure that disproportionately impacted the health of low-income populations and communities of color.

Equitable Health Outcomes are Necessary to Achieve Climate Justice.

2007 | The heart of “Cancer Alley,” the predominantly black town of St. James, Louisiana was re-zoned from residential to industrial, allowing for fifteen large industrial sites to develop there over the years.

2016 | The EPA finalized the framework for the Environmental Justice

2010 | Environmental Justice is made an agency-wide priority at the EPA.

24 22 20 18 16 14 12 10 8 6 4 2 0

2020 | EPA creates Action Agenda to address “significant national environmental justice challenges facing the nation’s minority, lowincome, tribal, and indigenous populations.”

2014 | Flint, Michigan changed its water source to save money, leading to high levels of lead in the water, poisoning the predominantly black and lower income populations of the city. 2005 | Local and state government were slow in responding to predominantly Black areas of ravaged by Hurricane Karrina in New Orleans, Louisiana. Residents were stranded. There were nearly nearly 2000 fatalities.

2014 | Federal and state governments approved Energy Transfer Partners’s plan to build the 1,200-mile Dakota Access oil pipeline crossing under and endangering Lake Oahe, a reservoir that serves as the Standing Rock Sioux tribe’s main source of drinking water.

2000

Climate justice emerged in response to the growing risk of climate change and recognition that it will disproportionately impact already marginalized groups. Organizing is sustained at the local level by community-based organizations with financial support from philanthropic foundations as federal priorities shift and policies vary under each administration.

Rising Risk in New York City easily and release it very slowly, creating dangerous indoor environments for days after an outdoor heat wave passes. Nearly one-quarter of New York residents live without air conditioning due to a combination of the cost to purchase units, the ongoing utility costs for use, and inferior electrical capacity in residential buildings.

Focusing this conversation on New York City, it is imperative to amplify the relationship between public health and the design of the built environment. Barriers exist on many fronts, but especially in connecting practitioners to identify opportunities for improvements; access to funding for implementation and maintenance, and embedded policies to mandate responses and establish accountability.

New York State and New York City developed a Heat Vulnerability Index to identify the most vulnerable neighborhoods to extreme heat.11The city’s Cooling Center program stems from the need to escape the dangers of high temperatures compounded by the urban heat island effect. Ultimately, treatment of heat-exacerbated illnesses falls solely on the medical and health system. It is in this

Understanding the specific role that the built environment plays is an important first step in reducing risks of climateexacerbated illness. The median age of residential buildings in New York City today is 90 years and 90% of the one million buildings that exist today will be here in 2050.10 New York’s aging, masonry-constructed buildings absorb heat

Health Risk Created by the Built Environment

LAND USE DECISION

PRIMARY EFFECT

SECONDARY EFFECT

AVAILABLE SOLUTIONS

East Harlem Asthma Center of Excellence

The Cost of Heat Events in New York City New Yorkers experience about 10 days per year above a heat index of 90 degrees. Researchers predict that by the 2080’s, this will increase to anywhere between 24 to 75 days. By the 2050’s, the city will feel the effects of not 2, but 6 heat waves every year. On average, heat events lead to about 13 heat stroke deaths and 115 premature deaths associated with excess heat, in addition to 450 emergency department visits and 150 hospital admissions for heat-related illnesses.12 We estimate that the associated costs total ~$100 million every year, given the valuation methods used in similar studies. Mortality costs from heat stress account for over 96% of the total, with the remainder stemming from morbidity costs (ED’s, HA’s, & OC’s). However, the value may indeed be 6

higher given that the mortality numbers only include deaths directly related to heat on death certificates, which represent a small proportion of all heat-related deaths. By 2080, the number of such heat-related fatalities is expected to double under researchers “best-case” scenario. However, it could as much as quadruple if no adaptations are made and the population continues to rise.13

separation of responsibility that the lack of relationship between health and the built environment becomes particularly acute. Today, medical professionals treat exhibited symptoms through prescription drugs or other topical solutions, but are not empowered to implement solutions that address the root of the health problems. Interventions in the built environment could significantly alter the health outcomes in New York Cityâ&#x20AC;&#x2122;s most vulnerable neighborhoods and mitigate against the risk of climate change exacerbating these concerns. To undo these patterns, our notion of preventative care must change.

Preventative Care must include Design of the Built Environment.

Broken links and isolated networks treat symptoms without eliminating the root causes.

Vital Brooklyn is a $1.4 billion health-focused community development program for Central Brooklyn. The state-funded program consists of 8 areas of investment: Open Space & Recreation; Healthy Food; Education; Economic Empowerment; Community-Based Violence Prevention; Community-Based Health Care; Affordable Housing; and Resiliency. The two most significant areas of investment are Community-Based Health Care ($700 million) and Affordable Housing ($563 million). Community-Based Health Care is being developed through a new system called One Brooklyn Health that unites three local hospitals in addition to opening 32 community health facilities. The second biggest area involves building green and healthfocused affordable housing incorporating supportive uses such as nonprofit and medical space. $140 million is also dedicated to open space and other programming, including the conversion of 8 asphalt schoolyards into playgrounds with new equipment, vegetation and in some cases green infrastructure.

The East Harlem Health Outreach Partnership is a free clinic for uninsured residents of East Harlem, New York. The clinic - organized, operated, and staffed by attending physicians and medical students from Mount Sinai Hospital - provides a wide range of services - primary diagnostic care, pharmaceutical support, social and counseling services, and a legal aid clinic (as a partnership with Columbia Law School). Many patients face chronic illnesses and suffer from an extreme lack of access to healthcare. EHHOP provides health care to those who would otherwise have no access. This care includes considerations of the social determinants of patient health, including dietary considerations, food access, and building and home health. When a health issue is determined to be potentially influenced by the state of the home, patient care expands to checking the quality of the living environment and providing funding for home cleaning or minor retrofit. The clinic is funded through a combination of 340B Program funding, philanthropy and in-kind services.

Heat Urban Heat Island Effectccesary “heat islands” are a phenomenon in which urban areas are hotter than nearby rural areas. The annual mean air temperature of a city with 1 million people or more can be 1.8-5.4°F warmer than its surroundings. In the evening, the difference can be as high as 22°F.

Air Conditioning is a solution to heat vulnerability. Air conditioners also contriubte to the problems that cause heat vulnerability

Urban density, lack of vegetation, and materials with significant thermal storage capacity and surface radiative properties are contributors to the urban heat island effect. Asphalt pavement, asphalt roofing, concrete, stone, brick, and glass all have negative implications.14

1/2 MILE

Cooling Centers Nearly one third of New York City’s senior citizens (some 353,182 individuals aged 65 or older)live more than a half-mile from a cooling center.15

Heat Risk Factors2 RISING TEMPERATURES

at least 37 STATES saw record high temperatures in the summer of 2010

more frequent heatwaves

BUILDING

7,415 DEATHS were attributed to excessive natural heat from 1999 to 2010 urban heat island effect

dehydration

heat stroke

aggravated cardiovascular illnesses

aggravated respiratory illnesses

URBAN

OUTDOOR :: HEATWAVE, DAYS 1-3 DAY 1

DAY 3

DAY 5

INDOOR :: DANGEROUS CONDITIONS, DAYS 3-5

Buildings with a high thermal mass absorb heat and release it slowly over time. During a heat wave, the buildings absorb and store the excess heat, continuing to release it after the heat wave weather pattern has ended. This creates indoor temperatures that are most dangerous after the heat wave weather pattern has passed. Access to Emergency Services ends when the heat wave weather pattern ends.

Most heat-related health complications are associated with a body’s inability to regulate its temperature. The body adapts by increasing radiant, convective, and evaporative heat loss by vasodilation and perspiration.13

The effect of higher temperatures on human health is largely due to an inability to escape the heat. In New York City, the Cooling Assistance Benefit Program provides eligible residences with a subsidy of $800 for the costs of an air conditioner or fan. Administered through NYC Human Resources Administration, the program is offered to people meeting particular income qualifications and whom have pre-existing medical conditions exacerbated by heat. Eligible applicants may receive the benefit once every ten years and it is administered on a first-come basis with applications opening and closing during the peak summer months.

Heat and heatwaves have an adverse effect on people with impaired physiological and behavioral responses due to heat. This can be further amplified by age, socioeconomics, preexisting chronic diseases, use of certain medications & environmental conditions.16

Higher ambient temperatures have been associated with pre-term births. Young mothers face an 8.6% higher risk; there is further variation by race.16

During extreme heat events, loosely defined by the CDC as an extended period of time with unusually hot weather, New York City opens Cooling Centers to the public. Cooling Centers are free air-conditioned public spaces that have a set time of operation and provide residents with water upon request. As a means of communication, the City utilizes multiple forms of media and mobile alerts to inform the public of the ensuing extreme heat event. The locations of the Cooling Centers are disseminated though NYC Emergency Management’s website, when an eminent extreme heat event is present.

Heat & Medication A study led by the University of Maryland found that in Baltimore, during the summer of 2018, there was an increase in 40% of emergency calls related to psychiatric conditions when the heat index rose over 103.

BODY Heat stroke occurs 12–23 times more in people 65 and older compared with other age groups.

Diseases exacerbated by HEAT Migraines, due to dehydration Multiple sclerosis, due to increase in body temperature Respiratory illnesses, asthma, COPD, lung cancer, due to higher ozone or particulate count during summer heat.17 Hyperthermia (heat-related illnesses)17 heat stroke :: due to prolonged exposure to high temperatures, core body temperature of greater than 104°F

Jeanetta Churchill, a resident of Baltimore, is diagnosed with a bi-polar disorder and is obligated to regulate her body temperature carefully, so heat does not exacerbate her symptoms. Medications such as antipsychotics can interfere with the body’s ability to regulate temperature, leading to dehydration or heat stroke. Jeanette relies on her air conditioner during summer months to manage symptoms.

Andrea Landry-Brown, also a resident of Baltimore has suffered hallucinations during heatwaves while taking Lithium and a combination of other medications to manage her post-traumatic stress disorder, bipolar disorder and anxiety. Lithium, a drug often used to treat bipolar disorder can significantly increase the risk of dehydration especially during a heat wave.

heat cramps :: due to loss of large amount of salt and water heat exhaustion :: due to exposure to high temperatures Symptoms vary, ranging from headaches, sweating, lack of sweating and nausea to confusion, shallow breathing, rapid heartbeat, and seizures, and in extreme cases, brain damage and organ failure

Heat Annually, more heat-related deaths occur in New York City than from all other extreme weather events combined.

Heat Vulnerability Index Score

New York City is particularly susceptible to this hazard due to its dense urban environment, which absorbs and traps heat. In New York City, extreme heat events are defined as periods when the heat index is 100°F or higher for one or more days, or when the heat index is 95°F or higher for two or more consecutive days. The risk of people and infrastructure suffering adverse effects from extreme heat increases as the temperature and the heat wave’s duration increases.1 The National Weather Service (NWS) uses a heat index chart to determine the effects of particular combinations of temperature and humidity will have upon the general population.18

Score (Lowest 1 - Highest 5), 2010 1

Hazards from extreme heat are made worse when accompanied by high humidity and/or poor air quality High humidity: Hazardous conditions are worse if the amount of moisture in the air and the temperature are both high. A combination of temperature and humidity —what the temperature “feels like” — is known as the heat index. Poor air quality: During the summer, stagnant atmospheric conditions can trap humid air and pollutants, such as ozone, near the ground. Ozone, a major component of smog, is created when pollutants emitted by cars, power plants, industrial boilers, and other sources chemically react in the presence of sunlight, making it hard to breathe.

Heat Vulnerability The Heat Vulnerability Index uses social and environmental factors to determine the relative risk of NYC neighborhoods for heat related death during and immediately following extreme heat events.11 The social factors used are poverty, as measured by the percent of people receiving public assistance, and race. The environmental factors used are daytime summer surface temperature and green space, such as tree, shrub and grass cover.

The Heat Heat Index Index1 The

Relative Humidity (Percent)

Air Temperature (F°) 95 100 105 110 115 120 125 130 135

97 102 107 111 146 122 128

99 103 107 111 117 120 125

95 100 105 111 116 123 131

97 102 108 115 123 131

99 105 112 120 130 141

94 101 109 117 127 139

96 104 113 123 135 148

98 107 118 130 143

93 101 110 123 137 151

95 104 115 129 143

96 107 120 135 150

98 110 126 142

90 100 114 132 149

91 102 119 138

93 106 124 144

95 109 130

97 113 136

99 117

88 102 122

100

89 105

91 108

Fatigue possible with prolonged exposure and/or physical activity Sunstroke, heat cramps and heat exhaustion possible with prolonged exposure and/or physical activity Sunstroke, heat cramps and heat exhaustion possible with prolonged exposure and/or physical activity Heat/ sunstroke highly likely with prolonged exposure

Observed Annual Temperature in Central Park (1900 — 2011) Observed Annual Temperature in Central Park (1900-2011)1 58

Farenheight ( F°)

Trend= +0.25°F Per Decade

56 55 54 53 51 50 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010

Historic & Future Occurrences The 2015 New York City Panel on Climate Change (NPCC) report estimated that from 1971 to 2000, New York City had an average of 18 days per year where maximum temperatures reached 90°F or more and had heat waves lasting an average of four days.19 Since the late 19th century, the number of days that New York City has experienced with temperatures of ninety-degrees or higher has increased. In the future, the number, duration, and intensity of heat waves at or above 90°F are expected to continue to increase as a result of climate change. The NPCC report notes that climate scientists predict that by the 2050s, New York City could experience as many ninety-degree days annually as Birmingham, Alabama, does today – more than triple the 18 days we experience in an average year.

Population Living in Poverty

Population of Color

Percent , 2013-17 4.3%

Percent Non-White , 2012-16

9.9%

14.2%

20.6%

29%

57.8%

5.2

Older Adults Living Alonge >65 Years

58.5

83.2

96.1

99.6

15%

20%

25%

46.9%

Tree Canopy Cover

Percent , 2014

Percent , 2012-2016 17.6%

34.7

25%

31.7%

37.7%

7.1%

58.7%

10%

Heat Wave of 2006

Heat Wave of 2013

A long, intense heat wave from July 27 through August 5, 2006 caused 40 heat stroke deaths in NYC. In addition, the average death rate from natural causes (excluding heat stroke) is estimated to have increased by 8%, or approximately 100 deaths, during that time.20

An extreme heat event that occurred July 14 to 20, 2013, was among the three most severe in New York City since 2000, with heat indices reaching at least 95°F for seven consecutive days and peaking at 109°F.20

53% of heat stroke deaths occurred among adults aged 65 years or older

33% of heat stroke deaths occurred among adults aged 65 years or older

68% of deaths were among those with known cardiovascular disease 28% had a known psychiatric or cognitive disorders 23% had diabetes

More than half (58%) had a cardiovascular condition cardiovascular

disease 21% had a serious mental health or psychiatric or cognitive disorders More than one quarter (29%) had a history of diabetes

Multiple medical conditions were identified for more than two-thirds (68%)

More than one third (38%) were reported to have evidence of alcohol

or drug abuse at the time of illness onset or had a history of chronic substance abuse.

of people who died from heat stroke

Only 2 of the 40 people who died

conditioner in their home

8 out of 9 (for whom information about home air conditioning was available) did not At least six of the decedents exposed at home were

were known to have a functioning air

have a working air conditioner. using fans at the time of death

More than half of those who died (53%) were living with someone at the time of their death.

Of those who died or were exposed at home, ten (59%)

did not live alone.

Quantitative Changes in Extreme Temperature Events1 2020s

2050s

2080s

Baseline (1971-2000)

Middle Range (25th-75th percentile)

High End (90th percentile)

Middle Range (25th-75th percentile)

High End (90th percentile)

Middle Range (25th-75th percentile)

High End (90th percentile)

Number of days per year at or above 90°F

26 to 31

39 to 52

44 to 76

Number of heat waves per year.

3 to 4

5 to 7

6 to 9

Average duration (days)

5 to 6

5 to 7

Heat Waves

Air

In 2011, 76% of renter-occupied homes in East Harlem had maintenance problems such as leaks, cracks and holes. In 2018, Fordham and University Heights, Highbridge, Concourse, Crown Heights and Prospect Heights 77% to 82% of renter-occupied homes reported maintenance defects such as water leaks, cracks, holes and presence of vermin. These neighborhoods are also where the highest rates of childhood asthma emergency department visits occurred in 2018. 28, 29, 31

New York City recently estimated that up to 2,700 premature deaths a year could be attributed to fine particulate matter and ozone in the air—more than eight times the number of murders that took place in 2013.21

Ozone levels are directly driven by weather, since ozone generatingphotochemical reactions of air pollutants (nitrogen oxides, methane, VOCS) need high temperatures and bright sunshine.25

Ozone entering a building reacts with some organic compounds to produce secondary indoor air pollutants. These reactions lower indoor ozone concentrations but introduce new indoor air contaminants, including other respiratory irritants.26

Air Quality Risk Factors2

AIR QUALITY

If there are climate-induced rises in indoor dampness, there could be increases in adverse health effects related to dampness and mold, such as asthma exacerbation.27

About 45% to 75% of a person’s overall exposure to ozone will occur indoors and about half of the health effects resulting from any outdoor increases in ozone will be due to indoor ozone expsures.27

3,600 EMERGENCY ROOM visits for asthma in adults due to particculate matter exposure in New York City.

Aggravated Cardiovascular Diseases

Increased Pollution & GHG Emissions

More Intense Wildfires

up to 15% increase in CARDIOVASCULAR DISEASE mortality risk with increased particular matter.

the length of RAGWEED SEASON increased by: Minneapolis, MN 21 days Increased Allergens

Aggravated Respiratory Diseases

Living in neighborhoods with high ambient pollution levels increases vulnerability to higher levels of groundlevel ozone from rising temperatures.24

BUILDING

5% increase in HOSPITAL VISITS due to Asthma following the Southern California wildfires of 2003.

Fargo, ND 19 days

Increased Allergy Related Illnesses

URBAN

Warming causes plants, like ragweed, to grow more and produce more pollen, and lengthens the pollen season. In some parts of the U.S., ragweed season is already about 3 weeks longer than it used to be, causing a big problem for people with allergies.22

In 2014, only 10% of NYC’s commercial putrescible garbage trucks met 2007 EPA emission standards – meaning that the vast majority of commercial waste trucks emit significantly greater quantities of harmful particulate matter and nitrogen oxide compared to the standard collection vehicles. On the other hand, one waste barge from a Marine Transfer Station can displace 48 long haul diesel waste export trucks.23

The indoor air in U.S. homes are linked to approximately 4.6 million cases of worsened asthma and between 8% and 20% of several common respiratory infections, such as acute bronchitis.27

Asthma is a chronic illness characterized by inflammation and hyper-reactivity of the airways that can worsen when exposed to triggers such as pests, mold, pollen, cigarette smoke, and air pollution.

The Breathe Easy Homes program was created by the Seattle Housing Authority to provide a home environment specially designed and built to reduce asthma triggers, the most common chronic health condition among children. They built 60 Breathe Easy Homes with special air filter and ventilations systems, and a construction sequence to minimize mold. A study of the homes found that children experienced 63 percent more symptom-free days,showed dramatic improvements in lung functioning, and there was a 66 percent reduction in the need for urgent medical care.

Higher ozone levels result in more asthma attacks, more heart attacks, decreases in lung function, and increased hospital admissions and deaths.30

The Active Design Guidelines provide designers with strategies for creating healthier buildings, streets, and urban spaces. The Center for Active Design centers its work around crossdisciplinary collaboration to transform design and development practices with a health-centric equitable focus. In an effort to promote healthy housing alternatives in underserved communities, CfAD partnered with Fannie Mae and Fitwel to encourage the Healthy Housing Rewards program. This program encourages borrowers to incorporate health-promoting designs through discounted loans and a waiver of Fitwel certification costs. The Fitwel certification system provides 70+ evidence-based design and operational strategies to enhance health outcomes of multifamily housing. In CfADâ&#x20AC;&#x2122;s recent publication entitled Healthcare: A Cure for Housing, providing affordable housing to Medicaid patients was shown to contribute to a 12% reduction in overall healthcare expenditures, an 18% decrease in emergency department visits, and a 20% increase in the use of primary care services.

BODY

PM 2.5

combustion particles, organic compounds, metals, etc. 2.5 microns in diameter

PM 10

dust, pollen,mold, etc. 10 microns in diameter

human hair

50-70 microns in diameter

PM2.5 The microscopic pollution known as PM2.5 (because the airborne particles are less than 2.5 micrometers in diameter, or one-thirtieth the size of a human hair) â&#x20AC;&#x201C; is a byproduct of burning and commonly comes from power plants, car exhaust, building heating oil, and wildfires. It is particularly harmful to human health, causing asthma and respiratory inflammation and increasing the risk for lung cancer, heart attack and stroke.

Air Childhood Asthma Rates Significantly Higher Among Low Income Populations

Asthma-Related Hospitalizations Among Children 0 - 17 Residing in Mott Haven versus New York City, 2015 Asthma-Related Hospitalizations Among Children 0 - 17 Residing in Mott Haven versus New York City, 2015

There is an indisputable correlation between childhood asthma rates and poverty in New York City. The neighborhoods most affected by Mott Haven this disparity are in the Bronx. In 2010, nearly one third of the 39,000 Mott Haven children in New York City who went to the Emergency Department for asthma-related reasons were from the Bronx. As of 2011, New York City Department of Health determined that the asthma hospitalization rate for children in the Bronx was 70 percent higher than the rest of New York New York City City. Over 2016-2017, 32-35 percent of children in grades K through 5 Asthma-Related ED Visits for Children 5 - 17 Years (Annual Rate per 10,000 Residents ) New York City were chronically absent, meaning they missed 19 or more school days Asthma-Related ED Visits for Children 5 - 17 Years (Annual Rate per 10,000 Residents ) over the year.32, 33, 11

Per 100,000 Residents,

Community groups in the South Bronx recently initiated their own neighborhood air pollutant monitoring study and found that their neighborhoods have the highest concentration of asthma-inducing pollutants like PM2.5 in the city. Their data showed air pollutant levels that were up to seven times higher than other parts of the Bronx. This disparity is owed to a disproportionate exposure to diesel truck exhaust from trucks serving the cityâ&#x20AC;&#x2122;s commercial waste facilities, regional food center in Hunts Point, and other adjacent maritime and industrial activities. Additionally, poor housing conditions generate pests, mold, and leaks that trigger and exacerbate asthma.34

32-35 percent % of children in Grades K

2016-2017, Over Over 2016-2017, 32-35

of children in

through 5 were chronically absent, meaning they missed grades K through 5 were chronically absent, meaning they missed

19+ school days over the year. 19+ school days Asthma-Related Emergency Department Visits Among Children Ages 5 - 17

over the year.

Asthma-Related Emergency Department Visits Among Children Ages 5-17

Percent in Poverty

50%

40%

30%

20%

10%

100

200

300

400

500

600

Asthma-Related ED Visits for Children 5 - 17 Years (Annual Rate per 10,000 Residents ) Asthma-Related Emergency Department Visits for Children Ages 5-17

Rent Burdened Households

Carbon

NO2

SO2

Co o 20 kin .4 g %

Aviation

Buildings 50.0%

Gas 11.2%

oa nR No % .4 19

Electr ic 7.1%

Marine Vessels 3.1%

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ation

a Ro n o N .3% 15

ust nD ctio .1% stru 5

Black

Tr a 17 ffic .3%

Con

Combustion of heating oil and natural gas

PM2.5

Tru 12. cks 2%

Residual Oil 3.1%

Indicators

Road Dust 6.1%

Levels of PM2.5 are highest in areas with higher traffic density, higher density of buildings with heat and hot water boilers, and industrial areas. As New York City needs to re-think the infrastructure systems that contribute to PM2.5 exposure and greenhouse gas emissions concurrently to design alternatives for solid waste handling, transportation systems, and building level heating. Research has shown that an all-electric bus transition would lead to a 97% reduction in fine particulate matter (PM ).23 2.5

ust Road D 6.1%

The microscopic pollutant known as PM2.5 is a byproduct of combustion activity inside and outside the city, including burning fuel in vehicles, buildings, power plants, and construction equipment as well as commercial cooking and industrial activity. This pollutant causes asthma and respiratory inflammation as well as increases risks of lung cancer, heart attack and stroke. The New York City Department of Health and Mental Hygiene (NYC-DOHMH) reports that exposure to PM2.5 is responsible for more than 3,000 deaths and 6,000 emergency room visits annually in New York City.35

rs Ca 1% 5.

Transportation and Building Systems are the Largest Sources of PM2.5 and other Pollutants

W 10 ood .2%

28 depots across five busbus depots across the fivethe boroughs, 75ofpercent ofin which are sited where in communities 75boroughs, percent which are sited communities the majority MTA operates TheThe MTA operates 28

where the majority of residents are people of color. of residents are people of color.36

Diesel exhaust from trucks traveling through industrial areas Motor vehicle emissions

Vegetative cover

Transportation accounts for 30 percent of Transportation accounts for of 36 greenhouse gasgas (GHG) emissions in New greenhouse emissions in New YorkYork City.City.

30 percent

Population of Color

Water Excess moisture on indoor materials leads to growth of microves, fungi, and bacteria leading to respiratory complications. 38 A warmer atmosphere can hold more moisture, and globally water vapour increases by 7% for every degree centigrade of warming. Total volume of precipitation is likely to increase by 1-2% per degree of warming. For cities with older infrastructure, this could mean flooding, pathogens from sewage overflow and displacement of noxious chemicals from industrial sites.39

Dampness can cause chemical and biological degradation of materials, polluting indoor air.38

Vector-Borne Disase Risk Factors2 VECTOR-BORNE DISEASES Increased Duration of Warm Season

Increased floording & storms

Changes in Median Temperature

42,000 cases of WEST NILE VIRUS in the US since 1999 of which more than 1,700 people have died.

Changes in Precipitation

Expanded Geographical Range

Incidences of LYME DISEASE DOUBLED from 1991 to 2015

Changes in Vector Behaviors

Increased Cases of Vector-Borne Diseases such as, Lyme Disease, Malaria, Zika Virus, and West Nile Virus

As temperature rises, the range of TICKS carrying LYME DISEASE will expand.

BUILDING

About 68% of California will have increased probability for West Nile Virus by 2050

URBAN Precipitation exerts a very strong influence, in diseases transmitted by vectors that have aquatic develomental stages (such as mosquitoes) and via humidity, on diseases transmitted by vectors without such stages, such as ticks or sandflies.42

Increased evaporation will result in more storms, but also contribute to drying over some land areas. Droughts can potentially cause increases concentration of effluent pathogens. Older water treatment plants are at risk.40, 41

produced in heavy

OR’ OR’ O

Phthalate

Naphthalene HO

1 in 5 people affected by West Nile Virus gets fever, headaches, muscle aches, joint pain.37

makes plastics

raw material for polyester

Lead

Ethylene Glycol

popular metal to use

neurotoxicity

O OR’ OR’

kidney toxicity Pb

blood toxicity

O OR’ OR’ O

Grassroots Research to Action in Sunset Park (GRASP) was formed to create a community-academic partnership to study chemicals of concern and to inform the community on how to minimize exposure. Sunset Park has a heavily industrialized waterfront with waste related facilities, chemical and oil bulk storage facilities, and small auto mechanic shops. In the wake of the flooding caused by Superstorm Sandy, residents expressed fear of the spread of toxic chemicals. However, as of 2012, there was no monitoring of these chemicals in the environment and thus no way to take action against it. GRASP teams set up a community based research program to monitor and characterize the chemicals of concern, determine exposure and health risk, and communicate to residents of their findings. The diagram above shows the four chemicals chosen to be monitored.

BODY Dampness is considered an indicator of risk of asthma and respiratory symptoms.38

GRASP is comprised of the New York City Environmental Justice Alliance, UPROSE, The LifeLine Group, and the RAND Corporation.

The Aedas albopictus mosquito is well adapted to urban life, needing just a small container filled with water to lay eggs.43

Water Heavy industrial areas can present a confluence of environmental burdens on communities A large portion of New York Cityâ&#x20AC;&#x2122;s coastline includes former industrial and manufacturing areas, many of which continue to thrive today. There are seven Significant Maritime Industrial Areas designated along the NYC waterfront that include a cluster of heavy industry and waste infrastructure. The Significant Maritime and Industrial Area (SMIA) is a special area designation of the NYC Waterfront Revitalization Program. SMIAs can include various toxic chemical facilities including major oil storage facilities, chemical bulk storage, heavy manufacturing sites, including Superfund Class 2 Sites. Superfund Class 2 Sites as defined by the NYC Department of Environmental Conservation, are inactive hazardous waste sites that represent a significant threat to public health and/or the environment and require action. Within close proximity to these areas are residential neighborhoods that are predominantly lower income communities of color. SMIAs are largely located within the 100-year floodplain, and are vulnerable to flooding from storm surges. With the proximity of these noxious chemicals and the waste related facilities, neighboring residential areas are especially burdened by the confluence of environmental hazards.

Community groups in the South Bronx and Sunset Park have taken initiatives to build the resilience of their respective communities through grassroots efforts to engage and empower residents.

Within SMIAs or within half Mile

Industry Sector Chemical Manufacturing

Fabricated Metal Product Manufacturing Primary Metal Manufacturing Electrical Equipment, Appliance Manufacturing

35 14

Petroleum Bulk Stations+Terminals, Chemical+Allied Products Wholesalers

Utilities

*as reported through TRI site

Source: NYC Environmental Justice Alliance

Many of the chemically intense businesses are auto body repair shops. These shops are typically local businesses supporting the livelihood of community members. As part of the strategy to clean up noxious chemicals, groups like GRASP and Uprose work with owners to strategize on how to maintain a cleaner shop.

According to GRASP, there are 800

hazardous chemicals from 2,235 sites in Sunset Park

Small Chemically Intense Businesses Superfund/Brownfields Solid Waste Facilities

Industrial Transportation Households/Private

There is a strong need for the City to strenghten existing programs and initiatives focused on preparedness measures with businesses and neighboring communities, as well as bolster research efforts to analyze the cumulative contamination exposure risks associated with clustered heavy industrial and manufacturing use, particularly given the compounded effects of rising sea-levels.

Much of NYC has a Combined Sewer system. CSO outfalls discharge over 20 billion gallons of polluted water into the New York Harbor every year44- this includes toxic metals and other hazardous substances from industrial effluent, street runoff, oils, solvents and cleaners down the sink drain or storm drains in the street.45 The New York City Department of Environmental Protection (DEP) is required to develop Long Term Control Plans (LTCPs) to reduce the overflows that discharge into New York Cityâ&#x20AC;&#x2122;s water bodies.

The Community Right-to-Know (RTK) Law requires the City to regulate the storage, use, and handling of hazardous substances. Through the RTK law, the DEP oversees the use and storage of hazardous substances that pose a threat to public health and the environment in the city. Businesses are required to file a report annually describing in detail the quantity, location, and chemical nature of every hazardous substance stored within their facility. This information is managed in a database by DEP, and inspections of facilities that store hazardous substances are conducted periodically to ensure compliance under the RTK Law.46

450+ CSO outfalls. Combined sewer systems make up nearly 60% of New York City has

New York City’s sewershed.45 CSO outfalls discharge

over 20 billion gallons of

polluted water into the harbor every year, including toxic metals & hazardous substances from industrial effluent. 45

1.5

Miles 12

Vector-borne Diseases Viruses like dengue, chikunguya, zika, and yellow fever are transmitted when a mosquito bites an infected human and then a healthy human

West Nile Virus is transmitted when a mosquito bites an infected bird and then a human.

ADULT Small puddles in cracks can breed mosquitoes

The Aedeas albopictus ( Asian tiger mosquito) is an invasive species native to Southeas Asia. They have become well adapted to the urban environment and colder temperatures of NYC needing only a small container of water to breed.

1” water

Climate variables influence the distribution of vector-borne diseases such Lyme, dengue fever, and West Nile virus disease. Changes in precipitation patterns can affect the length of a season that vectors can survive. Rain events, flooding and high humidity can result in the creation of areas conducive to vector-breeding. According to the National Resources Defence Council (NRDC), the US has experienced an increase in mosquito-borne illnesses.47 The CDC classifies New York state as a high-incidence area for Lyme disease, reporting nearly 2400 cases in 2018.48

EGG PUPA

LARVA

Mosquitos only need 1” of stagnant water. It only takes 10-14 days for breeding.

Common household containers providing stagnant water ideal for mosquito breeding range from as a rain barrel.

A Scalable, Integrated Response With the episodes of extreme heat becoming more frequent and thus exacerbating many existing chronic conditions, there is an opportunity for an integrated approach to Preventative Care Design. Many of the solutions are already being implemented in a piecemeal and siloed manner. Doctors are starting to refer patients with chronic conditions to local community groups that provide support in mitigating the negative impacts of the built environment on health. On the other hand, the city is addressing extreme heat vulnerability by providing air conditioning, programs for cool roofs, and promoting green infrastructure. These separate responses that tackle a common problem should be combined and coordinated to ensure that the clinical symptoms of the body and the environmental causes of these symptoms are both treated. There are currently gaps in protocols that hinder a more robust response to climate and built environment health concerns. Despite the historical grounding of the design of the built environment in health, robust feedback loops between public health officials, medical practitioners, and the designers of the built environment have not been established. Diagnosing and prescribing solutions within the built environment should include both health, built

environment professionals, subject-matter experts and community leaders familiar with the nuances of the issues being faced. Funding sources for both implementation and maintenance of solutions should be streamlined. Access to and continuity of data measuring the efficacy of the solutions helps to drive progress in this area. There must be a mandate that allows for the solutions to be implemented and to be maintained in perpetuity. In the short term, these solutions are reactive and correct for the conditions in the built environment that are making people sick. Once these immediate corrections are made, maintenance would be an exercise of long term proactive prevention of unhealthy conditions in the built environment. With data being collected to understand the long term implications of the initial solution, future solutions can pivot and adapt to the evidence. It is instrumental that solutions are given the time to unfold. As chronic illnesses have taken generations of living within an unhealthy environment to manifest in a population, immediate solutions that leave flexibility for long term proactive responses ensure that future generations will reap the benefits of Preventative Care Design.

Creating collaborations and networks to address problems at their source

Climate Change at the scale of the body

Heat and heatwaves have a more adverse affect on people with impaired physiological and behavioural responses due to heat. This can be further amplified by age, socioeconomic factors, pre-existing chronic diseases, use of certain medications and environmental conditions.

Higher ozone levels result in more asthma attacks, more heart attacks, decreases in lung function, and increased hospital admissions and deaths. 10 Most heat-related health complications are associated with aÂ bodyâ&#x20AC;&#x2122;s inability to regulate its temperature. The body adapts by increasing radiant, convective, and evaporative heat loss by vasodilation and perspiration.

Higher ambient temperatures have been associated with pre-term births. Young mothers face an 8.6% higher risk; there is further risk by race.

Dampness is considered an indicator of risk of asthma and respiratory symptoms.3

Asthma is a chronic illness characterized by inflammation and hyper-reactivity of the airways that can worsen when exposed to triggers such as pests, mold, pollen, cigarette smoke, and air pollution

Heat stroke occurs 12â&#x20AC;&#x201C;23 times more in people 65 and older compared with other age groups.

The microscopic pollution known as PM2.5 is a byproduct of burning and commonly comes from power plants, car exhaust, building heating oil, and wildfires. It is particularly harmful to human health, causing asthma and respiratory inflammation and increasing the risk for lung cancer, heart attack and stroke.

The Cost of Mitigation The cost of heat-mitigation renovation varies greatly across different scales, but can be categorized as simple, moderate, or substantial. Simple improvements include those contained within an individual unit, and are typically less than $1500/unit. For example, this would include the cost of a window air conditioning unit (including installation).49 Moderate improvements, on the other hand, include upgrades to major building components (such as windows, roof insulation, and ventilation upgrades) and cost around $1,000-$8,000/unit. Renovations at this scale can come

with major energy savings. Consequently, underwriting these savings may unlock additional load proceeds when a building is refinanced or purchased.49 Substantial improvements include gut renovations and comprehensive building overhauls (such as redesigning central HVAC, whole-building insulation, and air-sealing). At this level of renovation, construction loans will most likely be needed to finance the work, but underwriting efficiency savings can cover a substantial portion of the upfront costs.

Simple Upgrade Mitigation Strategy Costs

Moderate Renovation Mitigation Strategy Costs

Substantial Improvement Mitigation Strategy Costs

Modest updates to apartment units without changes to major building systems.

Updates to HVAC systems and controls, as well as building envelopes, units, and common areas.

Cost: $500-$1,500 per unit

Cost: $1,000-$8,000 per unit

Properties slated for guy renovation or adaptive reuse. New HVAC systems, renewable energy opportunities, building envelope renovation in addition to interior work

Examples:

Cost: $1,000-$8,000 per unit

Install in-unit air conditioning Weather-stripping Leak repair Common-area air sealing

Examples:

Roof insulation Window replacement Ventilation upgrades

Whole-building insulation Increase insulation Weatherization & air-sealing Window replacement Energy management systems

Facilitating Tenant-Attached Solutions Poor living conditions have a negative impact on health. Climate change often will exacerbate existing medical conditions and heighten the negative impacts of the built environment on health. Those with existing pre-conditions in low-income neighborhoods are particularly susceptible. While physicians are often aware of the impacts of the built environment on health, they do not have the tools to address them. For example, extreme heat worsens asthma symptoms. Extreme heat increases the level of air pollution while extreme humidity coupled with heat creates perfect conditions for growing mold. While doctors can treat the illness, organizations with expertise in the built environment must be deployed to address living conditions that are making people sick.

Physician makes referral for apartment inspection.

Outdoor Air Quality Air pollution has many sources including traffic, factories, and

power plants. Polluted air can cause health effects, especially in people with lung diseases like asthma, or heart disease.

Check your local air quality report. The Air Quality Index (AQI) provides information on air quality and actions you can take to protect your health (for example, limiting outdoor activity if the air quality is bad): www.airnow.gov If possible, plan outdoor activities away from major air pollution sources like the highway. Help reduce air pollution in your neighborhood –take public transportation, walk or bike when possible, and don’t idle your vehicle.

Inspection conducted according to existing apartment inspection protocols.

Prescription for equipment or physical improvement, covered by Medicaid.

Follow-up inspection to ensure prescription is effective.

Visit www.airnow.gov (or download the AirNow app) to find the Air Quality Index- a color-coded scale that tells how clean or polluted the air is:

For any AQI other than “Good”, AirNow will provide guidance on when to protect action to protect health (especially for sensitive groups, like children with asthma). USG= unhealthy for sensitive groups

Ask your child’s school to use Air Quality “Flag Program”: www.airnow.gov/index.cfm?action=flag_program.index For more information, visit: www.nyscheck.org/rx

Prescriptions for Prevention , provided by New York State Children’s Environmental Health Centers (NYS CHEC), were created by pediatricians and partners, to help inform New York families about how to address environmental health concerns within their homes and immediate surroundings. NYS CHEC is the first state-based model of pediatric environmental health services in the country, providing clinical consultation, environmental health screening as a part of routine wellness visits, and education and training for health and related industry professionals. NYC CHEC also partners with diverse local partners to develop and promote programs and policies that address pediatric environmental health concerns.

In order to tackle public health issues related to climate change, a holistic approach to include healthcare workers, community organizations, and those with knowledge of the built environment must be utilized. An integral component to this holistic approach to healthcare is data and evidence to show that interventions are working. While there are instances in which academic institutions partner with community based organizations and various built environment entities to understand health impacts of the built environment, the effort is not consistent. Community based organizations often lack the resources to conduct research on their own. With the challenges to health by climate change, data will be crucial to the understanding and effective management of healthcare especially for those with chronic conditions.

The Breathe Easy at Home program was created by the City of Boston to improve access and communication between medical homes for children with asthma, public health agencies, and housing agencies. The program aims to ensure that inspections are performed in a timely manner to resolve substandard living conditions. A shared web-based platform was created for doctors, nurses and other health professionals to refer patients with asthma for housing inspections if they suspect substandard housing conditions may be triggering a child’s asthma in their home. Inspectors also check for the presence of cockroaches, mice or mold or moisture problems which can exacerbate asthma in children. The program is a coordinated interagency effort between the Boston Public Health Commission and the Inspectional Services Department.

Leaky windows, doors, and air conditioning openings allow thermal transfer, exposing tenants to climate events. Windows without screens deter natural ventilation. Mold, pests, and dust mites can be caused by air pollution, extreme heat, and increased humidity, and all can be triggers for asthma attacks.

Poorly maintained air conditioning filters can introduce mold into the living space.

Physician referrals for inspections help identify opportunities for improvement and resilience.

Allergens and air pollution from the exterior can trigger asthma attacks and exacerbate chronic respiratory illness.

R Clean surfaces of dust and mold regularly with soap and water Clean air conditioner filters regularly Vacuum with a HEPA filter Patch damage to walls and watherstrip all windows, doors and other openings Employ non-toxic integrated pest control Open windows and turn on fans after showering and cooking to reduce moisture & increase ventilation

Delivery System Reform Incentive Payment (DSRIP) is a value based Medicaid program created in the interest of lowering medical costs and trips to the emergency room as part of the Affordable Care Act. DSRIP funding mandated health systems to work with community based organizations and local healthcare providers. Public health systems in New York State or hospitals serving at least 30% Medicaid users are eligible to be a Performing Provider System, an entity that manages the funding for the following initiatives: system and infrastructure redesign and clinical and population outcomes. Each PPS would create a network which includes healthcare providers, community health centers, and community based organizations to deliver on holistic healthcare to prevent re-admittance to hospitals. The program was a 5 year pilot program with the possibility of more funding and extension. In February 2020, the federal government elected to deny renewal of New York Stateâ&#x20AC;&#x2122;s DSRIP waiver. The current waiver will expire 31 March 2020.

Little Sisters of the Assumption is a neighborhood-based nonprofit, operating in East Harlem, which delivers a holistic model of human services. The Environmental Health Services Program was established in response to the high rates of asthma among children in East Harlem. As a response, community health workers actively assist families in identifying asthma triggers, modifying housing conditions and living habits to improve indoor air quality and asthma symptoms. Furthermore, they have assisted with repairs within homes. LSA has partnered with Mt Sinai as part of DSRIP to provide these services to residents. LSA has partnered with local and federal agencies to develop and evaluate performance metrics on their home remediation asthma program, which in 2017 has shown that 80% of school children in the program had fewer or no urgent care or emergency room visits as a result of their asthma. 23

Prioritizing Multi-Family Building Renovations In New York City; dense blocks of aging, multifamily masonry buildings are typical across high-HVI neighborhoods, absorbing and retaining heat during periods of high temperatures and amplifying health risks. These buildings were designed to protect against a colder climate, not the increasing heat waves and rising temperatures of today. Currently, impermeable pavement and buildings with high thermal mass store heat when temperatures are high, then slowly release it back into the atmosphere. Indoor temperatures then remain dangerously high after the sun sets and for days after a heat wave subsides, causing complications for children, the elderly, and those with existing chronic medical conditions like asthma. Progress has been made towards ensuring that NYCâ&#x20AC;&#x2122;s apartments are free of health hazards such as indoor allergens through various measures, including Local Law 55 of 2018.50 However, current mechanisms for enforcement still place the burden on the tenant to report their landlord to authorities, and many tenants may not feel secure enough to do so. Existing building inspection processes

Department of Buildings Facade Inspection Safety Program51

such as the Facade Inspection & Safety Program (FISP) should be expanded to account for the climate-exacerbated health hazards evident in a degrading building envelope. Currently, since FISP is meant to flag safety in terms of unstable facades, it only accounts for buildings 6 stories and above. The expansion of FISP could account for the health of renters in multifamily buildings of all sizes that are threatened by visibly degrading facades. The challenges and opportunities for reducing heat absorption among multifamily buildings are often related to the building envelope, renovations to which are capitalintensive and could prove cost-prohibitive to many property owners. To address the risks to human health, New York City must face the challenge to incentivize building owners to make capital investments that improve safety for residents and reduce the overall risk in their neighborhoods. This warrants a two-part solution that first, identifies buildings promoting climate-exacerbated health hazards and secondly, bridges financing to make them feasible while protecting renters.

Resources for Financing Renovations State New York State Weather Assistance Program (WAP) Property Assessed Clean Energy Financing (PACE) NYSERDA Clean Energy Fund Reforming the Energy Vision (REV) - Public Service Commission

City Cool Roofs - Mayorâ&#x20AC;&#x2122;s Office of Resilience Green Housing Preservation Program (GHPP) - NYC HPD Integrated Physical Needs Assessment (IPNA) - NYC HPD Program for Energy Retrofit Loans (PERL) - NYC HDC and NYC EEC Cracking, corrosion or spalling of masonry or concrete. Brick: separation along wythes or bulging. Fenestration sealants: evidence of water damage, gaps, improper installation, or adhesive failure. Windows: cracked parging at window jamb. Glass: Integrity of interior and exterior glass panes.

Participation Loan Program (PLP) - HPD

Private Lending and Grants ConEdison National Grid

Windows Single pane windows have a high U-Value, meaning they allow a lot of heat transfer between the interior and exterior.

Roof Retrofits will replace single-pane and lowperforming glazing with high-performance windows that achieve lower U-Values.

Roofs can be a source of air leakage resulting in low R-values and are often made of materials that attract and retain heat.

Improving roof insulation, a continuous air/vapor barrier, and considering higher albedo materials will help to improve roof performance and overall building envelope efficiency.

Facade An inefficient building envelope is considered inefficient allows high rates of heat transfer between interior spaces and the outdoor environment. This is often due to deficient insulation and inadequate sealing.

Improving facade performance requires a combination of air sealing, included but not limited to: overcladding*, recladding, employing air barriers, and caulking. These strategies also help to reduce mold, allergen infiltraiton, and pests. *overcladding may create fire safety concerns, and faces zoning constraints in NYC.

Weatherization Assistance Program (WAP) is a New York

PACE Financing was introduced in New York City as part of the

State program. Local service providers offer energy efficiency services to support weatherization of single- and multi-family buildings. Funding provides air sealing and improved insulation.

Climate Mobilization Act, NYC’s PACE (Property Assessed Clean Energy) is a financing mechanism that offers building owners up to 100% funding for the up-front costs of renewable energy & energy efficient projects. Loans are offered by private lenders and are repaid through a building’s property tax bill following a voluntary assessment of the improvements. The unique component of PACE funding is that assessments are property-specific and remain with the building, even upon sale. This is based on a financing structure called “land-secured financing district”, also known as local improvement district. In these, the local government issues bonds to fund projects with a public facing component, such as streetlights. The stated goal of the city’s implementation of PACE is to help building owners lower operation costs, increase property value, and create a healthier environment for occupants while meeting the requirements of the Climate Mobilization Act.

Priority for weatherization activities is given to households with children, the elderly, and persons with disabilities. Priority is also given to dwelling units occupied by households that receive Low-Income Home Energy Assistance (HEAP), those with high fuel costs in relation to their household income, and to properties where other state and Federal housing resources will be leveraged. Ultimately, 60 percent of the funds are allocated to renter-occupied properties. Funds from the Weatherization Assistance Program can only go to buildings with low-income tenants, and, if landlords use City funds, they have to agree to keep their buildings affordable for 15 to 30 years. The US Departments of Energy and Health and Human Services provide funds to the New York State Division of Housing and Community Renewal, which allocates funding to county service providers.

Mandating Climate-Driven Neighborhood Health Solutions Poor living conditions have a negative impact on health. Climate change is already exacerbating existing medical conditions and heightening the negative impacts of the built environment on health. Those with pre-existing conditions in low-income and high HVI neighborhoods are particularly susceptible. While physicians are often aware of the impacts of the built environment on health, they do not have the tools to address environmental causes. For example, rising temperatures increase the level of air pollution while extreme humidity coupled with heat creates perfect conditions for growing mold, an asthma trigger. In order to tackle public health issues related to climate change, a holistic approach is necessary. Medical professionals are only empowered to treat the symptoms; professionals in the built environment must be deployed

The dense urban fabric of New York City absorbs and retains heat, creating a heat island effect that amplifies heat wave conditions.

to address living conditions that are making people sick. Professionals in the built environment must support healthcare workers and community organizationsâ&#x20AC;&#x2122; ongoing work. An integral component to this holistic approach to healthcare is data and evidence to show that interventions are working, but community based organizations often lack the resources to conduct research on their own. While there are instances in which academic institutions partner with CBOs to understand health impacts of the built environment, the effort is not consistent, and the continuity of health metrics is crucial in this time of climate change. Sensors should be employed at community spaces such as schools, where a neighborhoodâ&#x20AC;&#x2122;s health metrics can be monitored continuously.

Burdensome infrastructure can greatly impact health outcomes, causing chronic health issues such as asthma.

Impermeable surfaces with reduced evaporative cooling capability, dark surfaces with poor surface reflectivity exacerbate extreme heat conditions.

Low tree cover and lack of shade can intensify the experience of being in the public realm during high temperature days, and can increase the risk of climate-exacerbated illnesses.

Replacing turf fields with grass, and asphalt surfaces with permeable pavers can increase evaporative cooling, mitigating the heat island effect and improving indivudal thermal comfort.

Partnering with utility companies, the city can working to improve below-grade constraints that delay or prevent public realm improvements and can pilot new methods and technologies.

East Harlem’s Neighborhood Health Action Centers is a comprehensive location for communities to seek various city resources for a multitude of health-related illnesses and concerns. The primary objective of East Harlem’s health action center is to reduce health disparities in the neighborhood. East Harlem’s Asthma Center for Excellence is an initiative through the action center, which focuses on providing various educational and support services to the community to aid best practices for children with asthma. The center has partnered with Harlem Health Advocacy Partners to assist residents in obtaining insurance alternatives and to help mobilize stakeholders in committing to the improvement of the neighborhood’s health. In addition, the action center also provides a wider variety of services, inclusive of primary care, mental health care, referrals, and health and wellness classes.

Labor-intensive mitigation improvements, and the need for ongoing maintenance are opportunities for both employment and the expansion of volunteer and stewardship programs.

Programs such as Safe Routes to School and Safe Streets for Seniors should couple pedestrian safety improvements with heat mitigation strategies which have numerous co-benefits

Nationwide Children’s Hospital launched Healthy Homes and the Healthy Neighborhoods Healthy Families (HNHF) initiative to expand access to affordable housing, and improve the quality of life for families in the south side of Columbus, Ohio. The programs aim to adopt a holistic approach to health by addressing socio-economic barriers that affect the well-being of families through investments in the neighborhood and strong partnerships with community organizations. Healthy Homes is the affordable housing prong of HNHF, which has impacted more than 350 homes on the south side -- this includes full-gut renovations, new builds with energy efficient and green features, and grants to current residents through the Home Repair Program. Homes typically feature tankless water heaters, rain barrels, solar tubes, low VOC paint, recycled carpet, levered door handles and energy efficient windows. Recent metrics indicate that investments in the neighborhood and the home environment have resulted in improvements in high school graduation rates, and greater neighborhood integration.

Glossary Anti-Resilience is the quality of resisting the obfuscation of systemic violence enacted upon communities of color and the poor in the name of energy. The act of engaging in a politics of anti-racism and anti-oppression that exposes the roots of structural inequality and vulnerability, and illuminates the path for system transformation. Shalanda Helen Baker

At-Risk describes exposure to the possibility of danger, harm, or loss. Oxford University Press

Building Envelope refers to the physical barrier between the exterior environment and the interior environment of a building. The thermal boundary created at the outermost perimeter of a building. The envelope is comprised of components and systems that protect the interior space from the effects of the environment (such as precipitation, wind, temperature, humidity, and sunlight). National Institute of Building Science.

The Built Environment includes all of the physical parts of where we live and work (e.g. homes, buildings, streets, open spaces, and infrastructure). The built environment influences a person’s level of physical activity. Center for Disease Control and Prevention

Climate-exacerbated describes a situation or condition which is worsened, not caused by, climate-related environmental conditions. This can include the worsening of existing or the emergent of new symptoms. self-defined

Climate Justice affirms the rights of communities dependent on natural resources for their livelihood and cultures to own and manage the same in a sustainable manner, and is opposed to the commodification of nature and its resources Bali Principles of Climate Justice, article 18, August 29, 2002

Climate Justice frames global warming and climate change as an ethical and political issue, rather than one that is purely environmental or physical in nature. This is done by relating the effects of climate change to concepts of justice, particularly environmental justice and social justice and by examining issues such as equality, human rights, collective rights, and the historical responsibilities for climate change. A fundamental proposition of climate justice is that those who are least responsible for climate change suffer its greatest consequences. Climate Justice can also be used to mean actual legal action on climate change issues. Wikipedia

Climate Resilient Development Pathways are development trajectories include both mitigation and adaptation, as well as effective development institutions to realize the goal of sustainable development. Climate-resilient pathways represent iterative processes for managing change within complex systems, where unintended consequences are common owing to feedbacks, teleconnections, crossscale linkages, thresholds, and nonlinear effects.

Environmental Justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. This goal will be achieved when everyone enjoys: the same degree of protection from environmental and health hazards, and equal access to the decision-making process to have a healthy environment in which to live, learn, and work. U.S. Environmental Protection Agency

Equity & Access “When I think about health equity, I think about it from the vantage point of inequity, the serious disparities in health, and the lack vof attainment of good health because of lack of access. It’s hard to define equity without defining access. I see them as completely hand in hand. And access is really the ability to attain services that are commensurate with need. The opposite of inequity is health equity, which is access for all, and access to many disciplines. But access for all to good health is defined in fluctuating terms. In fact, many definitions of health actually come from a perception of what is good health for myself.” Dr. Yasmin Meah, October 2019

The Exposome is the measure of all the exposures of an individual in a lifetime and how those exposures relate to health. An individual’s exposure begins before birth and includes insults from environmental and occupational sources. Understanding how exposures from our environment, diet, lifestyle, etc. interact with our own unique characteristics such as genetics, physiology, and epigenetics impact our health is how the exposome will be articulated. Center for Disease Control and Prevention

Facade Inspection Safety Program (FISP) was previously known as Local Law 11 – relates to buildings in New York City. It requires that owners of buildings with six or more stories above grade have their exterior walls and appurtenances inspected periodically – as set forth by the commissioner – but at least once every five years. A Qualified Exterior Wall Inspector (QEWI) must inspect the structural soundness and connections of all balcony enclosures on a property. The QEWI will rate the facade in one of the following three categories:

Safe: The facade has no problems and is in good condition.

Safe with a Repair and Maintenance Program (SWARMP): The facade is safe,

but requires repairs/maintenance.

Unsafe: The facade has problems/defects that pose a threat to safety. Public

safety measures must be installed immediately. Unsafe conditions must be

corrected within 90 days

NYC Department of Buildings

A Health System is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations. Wikipedia

Healthcare is maintenance or improvement of health via the prevention, diagnosis, treatment, recovery, or cure of disease, illnes, injury, and other physical and mental impairments in people. Wikipedia

International Panel on Climate Change

Heat Vulnerability is measure of how likely a person is to be Emergency Response is the phase of the disaster-management cycle that often attracts the most attention and resources. During this phase, environmental health services may greatly affect the health and well-being of affected communities. World Health Organization

injured or harmed during periods of hot weather. Vulnerability to heat has been linked to individuals’ characteristics (health status, socio-demographics, etc) as well as certain aspects of the community where one lives (environment, community demographics). These characteristics or “heat vulnerability factors” can play an important role in one’s ability to adapt to heat. NYC Department of Health and Mental Hygiene

The Heat Vulnerability Index (HVI) was developed by the NY State Department of Health, HVI maps identify areas in the state where people are vulnerable to heat. New York City has its own HVI information, which can be found at the on the New York City Website on the Environmental & Health Data Portal.

Stability describes the ability of a system to return to an equilibrium state after a temporary disturbance; the more rapidly it returns and the less it fluctuates, the more stable it is.

New York City Department of Health and Mental Hygiene

Susceptibility describes the quality or state of being susceptible;

A Heating, Ventilation & Air-Conditioning System (HVAC) is designed to provide thermal comfort moderate indoor air quality through control of temperature, humidity, and the exchange of air. There are a number of types of HVAC systems, and the functions of heating, air conditioning, and ventilation can be separated for buildings that do not have central systems.

C.S. Holling

the state of being predisposed to, sensitive to, or of lacking the ability to resist something (as a pathogen, familial disease, or a drug); sensitivity. Merriam Webster

Sustainability describes the ability to be maintained at a certain rate or level; something that improves the quality of human life while living within the carrying capacity of supporting ecosystems.

Wikipedia IUCN/UNEP/WWF

Medicaid is a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care. Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017. America’s Health Insurance Plans

Medically Underserved Areas or Populations are designated by the Health Resources & Services Administration as having too few primary care providers, high infant mortality, high poverty or a high elderly population. Health Resources and Services Administration

Mitigation is the effort to reduce loss of life and property by lessening the impact of disasters. In order for mitigation to be effective we need to take action now—before the next disaster—to reduce human and financial consequences later (analyzing risk, reducing risk, and insuring against risk). It is important to know that disasters can happen at any time and any place and if we are not prepared, consequences can be fatal. Federal Emergency Management Agency

Preventative Care is routine health care that includes screenings, check-ups, and patient counseling to prevent illness, disease, and other health problems. Healthcare.gov

Public Health is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals. Charles-Edward Armory Winslow

Resilience a measure of the persistence of systems and of their ability to absorb change and disturbance and still maintain the same relationship between populations or state variables. C.S. Holling

Social Determinants of Health are the conditions in the

Tenant-attached is a term used to described solutions owned by the tenant which can be removed and relocated with tenant upon the end of tenancy. self-defined

Sustainable Development describes development that meets the needs of the present without compromising the ability of future generations to meet their own needs. Brundtland Commission, Our Common Future

Urban Heat Island (also Heat Island, Heat Island Effect) describes built up areas that are hotter than nearby rural areas. The annual mean air temperature of a city with 1 million people or more can be 1.8-5.4 degrees F warmer than its surroundings. In the evening, the difference can be as high as 22 degrees F. Heat Islands can affect communities by increasing summertime peak energy demand, air conditioning costs, air pollution and greenhouse gas emissions, heat-related illness and mortality, and water pollution. U.S. Environmental Protection Agency

Under-resourced communities are those that are underfunded, and those having insufficient resources. Wikipedia

Under-served communities have limited acces to health care services. Department of Health and Human Services

The Value of a Statistical Life is an estimate of the amount people are willing to pay for small reductions in mortality risks from adverse health conditions that may be caused by environmental literature. The EPA recommends using the central estimate of $7.4 million. U.S. Environmental Protection Agency

Vulnerability is the degree to which a population, individual, or organization is unable to anticipate, cope with, resist, and recover from the impacts of disasters.

environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, workplace, and neighborhood) have been referred to as “place.” In addition to the more material attributes of “place,” the patterns of social engagement and sense of security and well-being are also affected by where people live.

World Health Organization

Center for Disease Control and Prevention

Office of Energy Efficiency & Renewable Energy

Weatherization services are cost-effective, energy efficiency measures for existing residential and multifamily housing with incomeeligible residents. These services are derived by using a diagnostic energy audit and building assessment that determines the necessary energy efficiency measures for each unique home.

Resources 1

Extreme Heat

NYC’s Risk Landscape: A Guide to Hazard Mitigation, Chapter 4.5

California Senate Office of Research

https://www1.nyc.gov/assets/em/downloads/pdf/hazard_mitigation/nycs_risk_landscape_ chapter_4.5_extremeheat.pdf

How Climate Change Affects Your Health American Public Health Association

https://sor.senate.ca.gov/sites/sor.senate.ca.gov/files/Public%20Health%20Climate%20 Change%20LINKS_4%201126.pdf

https://www.apha.org/news-and-media/multimedia/infographics/how-climate-change-affectsyour-health

Extreme Heat: Warning Signs and Symptoms Center for Disease Control and Prevention https://www.cdc.gov/disasters/extremeheat/warning.html

Cooling Assistance Benefit Program

QuickStats: Number of Heat-Related Deaths, National Vital Statistics System, United States, 1999-2010

NYC Human Resources Administration | New York, NY

Center for Disease Control and Prevention

https://www1.nyc.gov/site/buildings/safety/facades.page

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6136a6.htm

Climate Change and Health: Understanding How Global Warming Could Impact Public Health in California

referenced on page 9 of gazette

Mortality Risk Valuation

Cooling Centers

U.S. Environmental Protection Agency

NYC Emergency Management | New York, NY

https://www.epa.gov/environmental-economics/mortality-risk-valuation

https://www1.nyc.gov/site/buildings/safety/facades.page referenced on page 9 of gazette

Determinants of Health: Health is more than medical care Goinvo

Heat & Medication Study

https://www.goinvo.com/vision/determinants-of-health/#references

University of Maryland | Baltimore, MD https://www.npr.org/2019/09/04/757034136/how-high-heat-can-impact-mental-health

referenced on page 9 of gazette

Estimating the Health-Related Costs of 10 Climate-Sensitive U.S. Events During 2012 Geohealth | Vijay S. Limaye, Wendy Max, Juanity Constible, Kim Knowlton https://agupubs.onlinelibrary.wiley.com/doi/abs/10.1029/2019GH000202

Heat Index National Weather Service https://www.weather.gov/safety/heat-index

Killer Heat in the United States: Climate Choices and the Future of Dangerously Hot Days Union of Concerned Scientists

Advancing Tools and Methods for Flexible Adaptation Pathways and Science Policy Integration NYC Panel on Climate Change 2019 Report | Annals of the New York Academy of Science

https://www.ucsusa.org/sites/default/files/attach/2019/07/killer-heat-analysis-full-report.pdf

https://www1.nyc.gov/site/orr/challenges/nyc-panel-on-climate-change.page

Resilience and Stability of Ecological Systems C.S. Holling | Institute of Resource Ecology, University of British Columbia, Vancouver, Canada; 1973

New York City Department of Health and Mental Hygiene Data Briefs, November 2006 and August 2014 Sarah Walters, Kathryn Lane, Eryn Murphy

http://pure.iiasa.ac.at/id/eprint/26/1/RP-73-003.pdf

https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief47.pdf

Anti-Resilience: A Roadmap to Transformational Justice within the Energy System Shalanda Helen Baker | Harvard Civil Rights-Civil Liberties Law Review, Vol. 54, pp. 1-48; 2019

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3362355

By the Numbers: Air Quality and Pollution in New York City State of the Planet | Earth Institute | Columbia University https://blogs.ei.columbia.edu/2016/06/06/air-quality-pollution-new-york-city/

New York City’s Roadmap to 80x50 NewYork City Mayor’s Office of Sustainability

https://www1.nyc.gov/assets/sustainability/downloads/pdf/publications/New%20York%20 City’s%20Roadmap%20to%2080%20x%2050.pdf

NYC Department of Health and Mental Hygiene

Towards More Comprehensive Projections of Urban Heat-Related Mortality: Estimates for New York City under Multiple Population, Adaptation, and Climate Scenarios. Environmental Health Perspectives | Elisaveta P. Petkova, Jan K. Vink, Radley M. Horton, Antonio Gasparrini, Daniel A. Bader, Joe D. Francis, and Patrick L. Kinney https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5226693/#!po=48.0769

Midway to 2030: Building resiliency and Equity for a justice transition NYC Climate Justice Agenda | NYC-Environmental Justice Alliance https://www.nyc-eja.org/wp-content/uploads/2018/04/NYC-Climate-Justice-AgendaFinal-041818-2.pdf

MRT Innovations in Social Determinants of Health Initiative https://www.health.ny.gov/health_care/medicaid/redesign/sdh/healthcare/olson.htm

Proceedings of the National Academy of Sciences in the United States of America | Ziska L, Knowlton K, Rogers C, et al. https://www.pnas.org/content/108/10/4248

Environmental & Health Data Portal http://a816-dohbesp.nyc.gov/IndicatorPublic/VisualizationData. aspx?id=2191,719b87,107,Summarize

Recent Warming by latitude associated with increased length of ragweed pollen season in central North America

Climate Change, Health, and Equity: Opportunities for Action Center for Climate Change & Health https://www.phi.org/uploads/application/files/ h7fjouo1i38v3tu427p9s9kcmhs3oxsi7tsg1fovh3yesd5hxu.pdf

Climate change, extreme weather events, air pollution and respiratory health in Europe European Respiratory Journal | De Sario M., Katsouyanni K., and Michelozzi P. https://www.researchgate.net/publication/234124039_Climate_change_extreme_weather_events_ air_pollution_and_respiratory_health_in_Europe

East Harlem Health Outreach Partnership Mount Sinai Hospital | New York, NY

Environmental Research Letters | Nazaroff, W.W.

referenced on page 7 of gazette

https://iopscience.iop.org/article/10.1088/1748-9326/8/1/015022/pdf

Vital Brooklyn New York State Government | Central Brooklyn, NY

https://health2016.globalchange.gov/

referenced on page 7 of gazette

Heat Island Effect

The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment U.S. Global Exchange Research Program, Climate and Health Assessment

https://www.ny.gov/transforming-central-brooklyn/vital-brooklyn-initiative-0

Exploring the consequences of climate change for indoor air quality

https://icahn.mssm.edu/education/medical/clinical/ehhop

Community Health Profiles 2015, Manhattan Comm. District 11: East Harlem

U.S. Environmental Protection Agency

King L, Hinterland K, Dragan KL, et al.

https://www.epa.gov/heat-islands

https://www1.nyc.gov/site/doh/data/data-publications/profiles.page

NYC’s Cooling Center Network Strangs Nearly A Third of City’s Seniors

Community Health Profiles 2015, Manhattan Comm. District 8: Upper East Side

Gothamist

King L, Hinterland K, Dragan KL, et al.

https://gothamist.com/news/nycs-cooling-center-network-strands-nearly-a-third-of-citys-seniors

https://www1.nyc.gov/site/doh/data/data-publications/profiles.page

Health effects of ozone in the general population. U.S. Environmental Protection Agency.

https://www.epa.gov/ozone-pollution-and-your-patients-health/health-effects-ozone-generalpopulation

Community Health Profiles 2018 | Map Atlas; The New York City Department of Health and Mental Hygiene, 2018

NYC’s Combined Sewer System SWIM Coalition: Stormwater Infrastructure Matters https://www.swimmablenyc.org/combined-sewers

Naidoo M, Traore K, Culp G, King L, Lopez C, Hinterland K, Gould LH, Gwynn RC.

Combined Sewage Overflows (CSOs) Riverkeeper: NY’s Clean Water Advocate https://www.riverkeeper.org/campaigns/stop-polluters/sewage-contamination/cso/

https://www1.nyc.gov/assets/doh/downloads/pdf/data/2018-chp-atlas.pdf

Breathe Easy Homes

Seattle Housing Authority | Seattle, WA https://www.seattlehousing.org/about-us/redevelopment/high-point-redevelopment/breathe-easyhomes referenced on page 13 of gazette

The Community Right-to-Know Program New York City Environmental Protection https://www1.nyc.gov/site/dep/about/community-right-to-know-program.page

Active Design Guidelines

Vector-Borne Diseases PublicHealth.org https://www.publichealth.org/public-awareness/climate-change/vector-borne-diseases/

Center for Active Design | New York, NY https://centerforactivedesign.org/guidelines/ referenced on page 13 of gazette

Center for Disease Control and Prevention https://www.cdc.gov/lyme/datasurveillance/maps-recent.html

Asthma Prevention and Management in Bronx, New York and New York State at Large. Klein, Jeffrey https://www.monroecollege.edu/uploadedFiles/_Site_Assets/PDF/Asthma%20prevention_Final. pdf

Lyme disease maps: Most recent year

Underwriting Efficiency Community Preservation Corporation http://communityp.com/resources/underwriting-energy-efficency-lender-handbook/

Community Health Profiles. 2018 New York City Department of Health and Mental Hygiene

Breathe Easy at Home

https://www1.nyc.gov/site/doh/data/data-publications/profiles.page

Boston Public Health Commission | Boston, MA https://www.bphc.org/whatwedo/healthy-homes-environment/asthma/Pages/Breathe-Easy-atHome.aspx referenced on page 22 of gazette

Seeking Environmental Justice in the South Bronx City and State New York | Serrano, Jose & Iachan, Melissa https://www.cityandstateny.com/articles/opinion/seeking-environmental-justice-in-the-southbronx.html

Prescriptions for Prevention New York State Children’s Environmental Health Centers | New York

http://nyscheck.org/rx/

Air Pollution and the Health of New Yorkers: The Impact of Fine Particles and Ozone

referenced on page 22 of gazette

NYC Department of Health and Mental Hygiene https://www1.nyc.gov/assets/doh/downloads/pdf/eode/eode-air-quality-impact.pdf

Delivery System Reform Incentive Payment 36

Medicaid Redesign Team | New York

Let’s Go: A Case for Municipal Control and a Comprehensive Transportation Vision for the Five Boroughs

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/ referenced on page 23 of gazette

New York City Council https://www1.nyc.gov/site/buildings/safety/facades.page

Environmental Health Services Program 37

Little Sisters of the Assumption | New York, NY

West Nile virus: Symptoms, Diagnosis, & Treatment Centers for Disease Control and Prevention

https://littlesistersfamily.org/

https://www.cdc.gov/westnile/symptoms/index.html

referenced on page 23 of gazette

Guidelines for Indoor Air Quality: Dampness and Mould.

World Health Organization, Europe

How will climate change affect rainfall? The Guardian https://www.theguardian.com/environment/2011/dec/15/climate-change-rainfall

Waterborne Diseases National Institute of Environmental Health Science https://www.niehs.nih.gov/research/programs/geh/climatechange/health_impacts/waterborne_ diseases/index.cfm

NYC Administrative Code https://www1.nyc.gov/assets/doh/downloads/pdf/asthma/local-law-55.pdf

http://www.euro.who.int/__data/assets/pdf_file/0017/43325/E92645.pdf

Local Law 55: The Asthma-Free Housing Act

Facade Inspection Safety Program (previously Local Law 11) NYC Department of Buildings https://www1.nyc.gov/site/buildings/safety/facades.page

Weatherization Assistance Program (WAP) NYS Division of Homes and Community Renewal | New York https://hcr.ny.gov/weatherization-providers referenced on page 25 of gazette

Climate Change Trends & Patterns

PACE Financing

Precipitation Measurement Missions | National Aeronautics and Space Administration, Goddard Space Flight Center https://gpm.nasa.gov/science/climate-change

Climate Mobilization Act | New York, NY https://www.nyceec.com/pace/ referenced on page 25 of gazette

Climate change and vector-borne diseases: what are the implications for public health research and policy? Philosophical transactions of the Royal Society of London. Series B | Campbell-Lendrum, D., Manga, L., Bagayoko, M., & Sommerfeld, J. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342958/

Neighborhood Health Action Centers NYC Department of Health and Mental Hygiene | New York, NY https://www1.nyc.gov/site/doh/health/neighborhood-health/neighborhood-health-action-centers. page referenced on page 27 of gazette

Dr. Maria Diuk-Wasser Columbia University Department of Ecology, Evolution, and Environmental Biology

Healthy Homes & Healthy Neighborhoods Healthy Families

telephone interview, September 17, 2019

Nationwide Children’s Hospital | Columbus, OH

Grassroots Research to Action in Sunset Park

https://www.nationwidechildrens.org/about-us/population-health-and-wellness/healthyneighborhoods-healthy-families referenced on page 27 of gazette

New York City Environmental Justice Alliance, UPROSE, The Lifeline Group, RAND Corporation | Brooklyn, NY https://www.rand.org/well-being/community-health-and-environmental-policy/projects/grasp.html referenced on page 17 of gazette

About this Gazette This publication is the culmination of the research and speculative design thinking completed for the 201920 Forefront Fellowship Program. In the first phase of the program, fellows studied heat vulnerability in New York City in partnership with the Mayor’s Office of Resilience. The second phase of the fellowship encouraged fellows to advance their research on climate justice and utilize speculative design thinking to identify opportunities to improve practices and outcomes in the built environment amid climate change. The effects of climate change events, felt acutely in neighborhoods across New York City, constitute a public health crisis. Further, they surface systemic inequities that make some neighborhoods more vulnerable to climate-exacerbated risks than others. Guided by these truths, this gazette, and accompanying policy paper, produced by some of these fellows argues that preventative care must include design of the built environment. This gazette does not propose a singular solution to the public health crisis posed by climate change. Rather, it is a consolidation of research and analysis; relevant precedents that demonstrate successful interventions; and insight gleaned from conversations with practitioners in public health, medicine, science, urban planning, policy, and design disciplines. This gazette places public health at the center of climate change. In doing so, we identify and suggest solutions to minimize gaps in the current research and practice between public health and climate change mitigation and response strategies. We assert that the metrics employed for climate change mitigation must be augmented to include public health outcomes. We plea for practitioners who are intervening in the built environment to collaborate with medical and public health partners to reconsider the opportunities their work presents for social equity and resilience. As Thad Pawlowski stated, “Leadership in the age of climate change will be more about network than hierarchy.” This work aims to begin building that network.

We would like to thank the following contributors: Jamie Bemis, Bright Power Toby Sheppard Block, Intervine Kizzy Charles-Guzman, Mayor’s Office of Recovery and Resiliency Nupur Chaudhury, NY State Health Foundation Dr. Maria Diuk-Wasser, Columbia University Dr. Maida Galvez, Mount Sinai Hospital Dr. Elizabeth Garland, Mount Sinai Hospital Jalisa Gilmore, NYC-Environmental Justice Alliance Douglas J. Lister, Architect Daphne Lundi, NYC Mayor’s Office of Recovery and Resiliency Dr. Yasmin Meah, Mount Sinai Hospital, Visiting Doctors Program & East Harlem Health Outreach Partnership Thaddeus Pawlowski, Columbia University Gretchen West, Nationwide Children’s Hospital Dattner Architects Sustainable Practice Group

We would like to acknowledge support from: Dattner Architects Robert Balder, Executive Director of Cornell AAP NYC Cornell University AAP NYC